title: A case of Wernicke encephalopathy combined with disulfiram intoxication.
abstract: There have been several reports of disulfiram intoxication, but little evidence of neurologic conditions resulting from disulfiram-induced brain damage combined with Wernicke encephalopathy-associated lesions. We report a rare patient with both Wernicke encephalopathy and disulfiram intoxication. This 50-year-old woman, who was taking disulfiram for chronic alcohol abuse, presented with an acute confusional state, dysarthria, nystagmus, supranuclear ophthalmoplegia, and paraparesis. Biochemical serum and cerebrospinal fluid analyses were normal. An electromyogram detected a motor polyneuropathy. Cognitive assessment revealed severe impairment of memory, attention, and logical and executive abilities. Magnetic resonance imaging with gadolinium enhancement showed brain lesions consistent with Wernicke encephalopathy, but also symmetric hyperintensities on T2-weighted images in the globus pallidus. Stopping the disulfiram and treating with hydration, high-dose thiamine supplements, and benzodiazepines significantly improved the patient's consciousness and oculomotor function. A magnetic resonance imaging scan after 1 month of treatment showed complete disappearance of the brain lesions and the hyperintensities in the globus pallidus. After a further month of intensive neurorehabilitation, the patient was able to interact with the medical staff, and her neuropsychological tests showed only mild memory impairment. Patients with alcoholism who present at emergency departments are at high risk for misdiagnosis, especially because there is no specific routine laboratory test for detecting asymptomatic disulfiram intoxication. Although uncommon, the combination of Wernicke encephalopathy and disulfiram intoxication should be suspected in patients with alcoholism. The disorder can be detected through a careful history and prompt clinical evaluation, together with characteristic magnetic resonance imaging findings.
authors.affiliation: National Institute of Neurology, Istituto Di Ricovero e Cura a Carattere Scientifico C. Mondino, University of Pavia, Pavia, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Tartara
authors.forename: Simona
authors.initials: S
authors.lastname: Fanucchi
authors.forename: Ignazio
authors.initials: I
authors.lastname: D'Errico
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Farina
authors.forename: Francesca
authors.initials: F
authors.lastname: Casoni
authors.forename: Elena
authors.initials: E
authors.lastname: Sinforiani
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Micieli
authors.forename: Alfredo
authors.initials: A
authors.lastname: Costa
mesh_terms: D000437:Alcoholism / Q000150:complications* / Q000188:drug therapy; D004221:Disulfiram / Q000506:poisoning* / Q000627:therapeutic use; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D014899:Wernicke Encephalopathy / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D005682:Gadolinium; D004221:Disulfiram